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ICC3 > interstitial nephritis > Flashcards

interstitial nephritis Flashcards

1
Q

what are tubulointerstitial disease ?

A

diseases affecting the tubules and the interstitial whilst sparing the glomerulus

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2
Q

is acute vs chronic interstitial nephritis reversible ?

A

yes , due to the preservation of basement membrane
chronic - there’s scarring and fibrosis and tubular atrophy

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3
Q

what are the causes of acute tubulointerstitial nephritis ?

A 
allergic 
immune 
infections 
generally associated with progressive AKI after the introduction off a new drug
a type of hypersensitivity reaction
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4
Q

what are the clinical features of acute tubulointerstitial nephritis ?

A 
rash 
fever 
eosinophilia 
elevated IgE
fanconi's syndrome 
patient may present with hematuria
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5
Q

what is fanconi’s syndrome ?

A

characterised by
glycosuria
aminoaciduria
phosphaturia
RTA

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6
Q

what does the renal biopsy in antibiotic induced acute tubulointerstitial nephritis show ?

A

shows eosinophils

occasionally ill defined granuloma

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7
Q

what lab changes may patients with NSAIDs induced interstitial nephritis present with ?

A

Nephrotic syndrome and massive proteinuria no eosinophilia and raised ALT

and have massive proteinuria with hypoalbuminemia

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8
Q

why is rifampicin induced interstitial nephritis different?

A

only ab that isn’t associated with eosinophilia

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9
Q

what are the lab investigation required ?

A

cbc with differentials
serum chemistry panel
urinalysis

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10
Q

what are the imaging investigations required ?

A

ultrasound , normal size kidney generally favors a diagnosis of acute kidney disease

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11
Q

what is the management for interstitial nephritis?

A

remove the causative agent
steroid therapy
treat any underlying disease along with supportive therapy

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12
Q

what is the regimen for giving steroid in AIN

A

methyprednisolone 1g/day day (initial pulse)
then prednisone 1 mg/kg for a period of time

predinsolone 1mg/kg for a period of time

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13
Q

what are the classification of interstitial nephritis ?

A

acute and chronic

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14
Q

what are the causes of chronic interstitial nephritis ?

A 
toxins ( lead , analgesia )
infections 
metabolic 
autoimmune 
radiation
neoplastic infiltration 
hereditary renal disease
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15
Q

what other name is given to the chronic form of interstitial nephritis ?

A

chronic tubulointerstitial nephritis

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16
Q

what is the onset of chronic tubulointerstitial nephritis

A

insidious onset

17
Q

what is the most common category of chronic interstitial nephritis ?

A

analgesic nephropathy

18
Q

in its most severe form what is analgesic nephropathy associated with ?

A

papillary necrosis in addition to chronic interstitial nephritis

19
Q

what are the clincal findings of patients with analgesics nephropathy ?

A

renal insufficiency
modest proteinuria
sterile pyuria
anemia

20
Q

what can aid the diagnosis of analgesics nephropathy ?

A

history of heavy use of analgesics
microcalcifications of papillary tip seen on CT

on CT there is evidence of micro calcifications at the papillary tips

21
Q

what is sterile pyuria ?

A

presence of WBCs in the urine with no evidence of bacteria

22
Q

what may the intravenous urography show in obstructive uropathy?

A

hydronephrosis

23
Q

what is lead nephropathy commonly misdiagnosed as ?

A

hypertensive kidney disease

24
Q

what is the classic presentation with lead nephropathy ?

A

hyperurecemia

gout is common

25
Q

what is the most common metabolic cause of nephropathy ?

A

hypercalcaemia

26
Q

with what diseases can hypercalcaemia happen with ?

A

hyperparathyroidism
multiple myeloma
vitamin d intoxication

27
Q

what is a complicating factor of hypercalcaemia ?

A

nephrocalcinosis

renal stone formation

28
Q

what is the management of chronic interstitial nephritis ?

A 
immunosuppressive therapy
kidney transplant 
dialysis 
phosphate binders 
calcium supplement 
epogen ( for the anemia)
29
Q

when should we consider using steroids in cases of AIN ?

A

if no improvement within 3-5 days ofd removing the offending drug

30
Q

what are the findings of renal biopsy of kidneys with allergic response to NSAIDs ?

A

minimal change nephrosis along with changes associated with interstitial nephritis

31
Q

What are the drugs known to cause ATN?

A

b lactams
cephalosporins
fluoroquinolones
NSAIDs
Diuretics
Rifampicin
Allopurinol
PPI

32
Q

What is the result of vesicoureteral reflux?

A

focal glomerulosclerosis with nephrotic syndrome

33
Q

What kinds of stones are associated with urinary tract infections?

A

ammonium magnesium phosphate stones

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